1073684874 NPI number — MARCELA G GUTIERREZ ARNP

Table of content: DR. JAMES RYAN CIAVARELLA D.C. (NPI 1437372802)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073684874 NPI number — MARCELA G GUTIERREZ ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUTIERREZ
Provider First Name:
MARCELA
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GRUBMAN
Provider Other First Name:
MARCELA
Provider Other Middle Name:
G
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
ARNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1073684874
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/05/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
615 E PRINCETON ST
Provider Second Line Business Mailing Address:
SUITE 416
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32803-1456
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-303-1687
Provider Business Mailing Address Fax Number:
407-303-1729

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
615 E PRINCETON ST
Provider Second Line Business Practice Location Address:
SUITE 416
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32803-1456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-303-1687
Provider Business Practice Location Address Fax Number:
407-303-1729
Provider Enumeration Date:
11/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  ARNP 3102182 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3030521-00 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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